Fragile Efficacy Signals Underlie DOACs for Cancer-Associated VTE

A fragility-index reanalysis of five DOAC-versus-dalteparin trials reframes how anticoagulation pharmacists should weight thrombotic benefit against bleeding harm in cancer-associated VTE.

apixabanedoxabanrivaroxabandalteparinDOACLMWHcancer-associated thrombosisvenous thromboembolismfragility indexmeta-analysisanticoagulationbleeding risksecondary prevention Cardiology / Anticoagulation

Background Information

DOACs for cancer thrombosis: Efficacy vs. bleeding risk.

Direct oral anticoagulants (DOACs) offer an alternative to low-molecular-weight heparin for cancer-associated venous thromboembolism (VTE), important in managing thrombotic risk in cancer patients. DOACs reduced recurrent VTE (number needed to treat (NNT) 17.7-41.9) but with a comparable risk of major bleeding (number needed to harm (NNH) 17.6-45). Fragility index (FI) indicated limited robustness in efficacy outcomes. DOACs are viable but require personalized assessment due to fragile benefits and bleeding risks. These findings need careful consideration in cancer care, balancing comorbidities and risks. DOACs in cancer-associated thrombosis are effective but fragile, demanding individualized risk assessment.

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Authors: Zuin M, Becattini C, Vedovati MC, Connors JM, Piazza G

Citation: Zuin M, Becattini C, Vedovati MC, et al. Direct oral anticoagulants in cancer-associated venous thromboembolism: trial robustness and clinical trade-offs. Research and practice in thrombosis and haemostasis. 2026;10(5):106844. doi:10.1016/j.rpth.2026.106844

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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